Esophageal cancer is a significant global health concern, ranking as the 11th most common cancer and the 7th leading cause of cancer-related deaths worldwide. In East Asia, particularly China, esophageal squamous cell carcinoma (ESCC) is the predominant type. For patients with locally advanced ESCC, the standard treatment involves neoadjuvant therapy, such as chemotherapy, chemoradiotherapy, or chemoimmunotherapy, followed by curative esophagectomy. However, despite advancements in surgical techniques and perioperative care, severe postoperative complications (SPCs) remain a major issue, impacting patient outcomes and survival.
Identifying reliable preoperative predictors of SPCs and understanding their impact on long-term survival is crucial for personalized treatment planning. One such predictor is preserved ratio impaired spirometry (PRISm), a distinct spirometric pattern indicating small airway dysfunction. Although often overlooked, PRISm affects a significant portion of the population and is associated with systemic inflammation and increased mortality. Its role in thoracic malignancies, including ESCC, has not been thoroughly explored.
Systemic inflammation, a key player in surgical recovery and cancer progression, is also a focus of this study. Various inflammation-based hematologic indices, such as NLR, PLR, LMR, SII, and SIRI, have emerged as cost-effective markers of immune imbalance and tumor-promoting inflammation. These indices have shown prognostic value in different solid tumors, including ESCC.
This study aims to fill the gap in knowledge by evaluating the impact of preoperative PRISm and inflammatory biomarkers on short-term (SPC incidence) and long-term outcomes (overall survival and recurrence-free survival) in ESCC patients undergoing neoadjuvant therapy and surgery. The goal is to develop predictive models that integrate respiratory function and immunoinflammatory status, providing a comprehensive risk assessment tool.
The study included 224 ESCC patients who underwent neoadjuvant therapy and curative esophagectomy. Results showed that patients with PRISm had a significantly higher incidence of SPCs, with pneumonia, anastomotic leakage, and atrial fibrillation being the most common complications. PRISm and decreased SIRI were identified as independent predictors of SPCs. Additionally, PRISm was associated with poorer long-term survival, highlighting the importance of routine pulmonary function testing, especially for high-risk surgical candidates.
The study also validated the prognostic significance of systemic inflammatory biomarkers, with decreased SIRI and low LMR predicting worse outcomes. These findings suggest that PRISm and systemic inflammation play crucial roles in postoperative complications and survival. The study developed nomograms integrating PRISm, inflammation, and pathology, which outperformed traditional TNM staging in predicting complications and survival.
While the study provides valuable insights and predictive tools, it has limitations, including its retrospective, single-center design and potential selection bias. Further prospective validation and exploration of biological mechanisms are needed. Nevertheless, the nomograms developed in this study offer a promising approach to personalized risk stratification and perioperative decision-making for ESCC patients undergoing neoadjuvant therapy and surgery.
